Identification of Seniors at Risk (ISAR) Screening Tool in the Emergency Department: Implementation Using the Plan-Do-Study-Act Model and Validation Results

Asomaning, Nana; Loftus, Carla

doi:10.1016/j.jen.2013.08.014

Cited by 39 publications

(36 citation statements)

References 13 publications

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“…Asomaning et al. showed that the Identification of Seniors At Risk (ISAR) tool could be administered in 52% of ‘eligible’ older ED patients [ 19 ]. However, in another study evaluating ISAR, the screening rate was 34% after implementation, followed by an increase toward 50% over the course of 7 months [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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Background risk stratification tools for older patients in the emergency department (ED) have rarely been implemented successfully in routine care. Objective to evaluate the feasibility and acceptability of the ‘Acutely Presenting Older Patient’ (APOP) screener, which identifies older ED patients at the highest risk of adverse outcomes within 2 minutes at presentation. Design and setting 2-month prospective cohort study, after the implementation of the APOP screener in ED routine care in the Leiden University Medical Center. Subjects all consecutive ED patients aged ≥70 years. Methods feasibility of screening was assessed by measuring the screening rate and by identifying patient- and organisation-related determinants of screening completion. Acceptability was assessed by collecting experienced barriers of screening completion from triage-nurses. Results we included 953 patients with a median age of 77 (IQR 72–82) years, of which 560 (59%) patients were screened. Patients had a higher probability of being screened when they had a higher age (OR 1.03 (95%CI 1.01–1.06), P = 0.017). Patients had a lower probability of being screened when they were triaged very urgent (OR 0.55 (0.39–0.78), P = 0.001) or when the number of patients upon arrival was high (OR 0.63 (0.47–0.86), P = 0.003). Experienced barriers of screening completion were patient-related (‘patient was too sick’), organisation-related (‘ED was too busy’) and personnel-related (‘forgot to complete screening’). Conclusion with more than half of all older patients screened, feasibility and acceptability of screening in routine ED care is very promising. To further improve screening completion, solutions are needed for patients who present with high urgency and during ED rush hours.

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Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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“…time pressure, competing demands, lack of resources and knowledge and perceived irrelevance of screening in this critical care environment (McCusker et al . , Asomaning & Loftus , Tavender et al . ).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework

Kirk

Sivertsen

Petersen

et al. 2016

Journal of Clinical Nursing

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Aim. The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. Background. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. Design. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. Methods. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Results. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. Conclusions. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. Relevance for clinical practice. The results show that different cultures exist in the same local context and influence the perception of barriers and facilitators difWhat does this paper contribute to the wider global community?• Culture forms professional role and identity, actions and sense making and provides different ways to perceive barriers and facilitators linked to new screening tools.• This emphasises the importance of understanding the local culture before any implementation strategy linked to screening tools is planned.• As researchers, we have to understand how new tools makes sense in a cultural context before planning any implementation strategies. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…As major limitation, only 41.2% of all eligible patients in our cohort received ISAR screening which, although comparable to other screening implementation trials [35], may not allow truly representative statements for older patient populations, which raises the need for cautious data interpretation. Further limitations are intrinsic to the nature of the ISAR and CGA instruments.…”

Section: Discussionmentioning

confidence: 83%

“…In 667 patients aged ≥70 years from emergency departments in the United Kingdom (mean age 80 years), 69% had a positive ISAR screening [34]. In 258 patients aged ≥65 years (mean age: 79 years) from a Canadian emergency department 61.2% screenings were positive [35]. About 40% of our cohort receiving CGA due to positive ISAR screening had an abnormal CGA defined as impairment of ADL plus another domain of the CGA.…”

Section: Discussionmentioning

confidence: 99%

Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment

et al. 2019

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Background Hospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay. Methods Five hundred forty-seven internal medicine in-patients (mean age 78.14 ± 5.96 years; 54.7% males) prospectively received Identification of Seniors at Risk (ISAR) screening. If screening results were positive (ISAR score ≥ 2), a comprehensive geriatric assessment (CGA) was performed. We explored sensitivity and specificity of different ISAR and CGA cutoffs. Further, we analyzed the risk of falls and how patients got discharged from hospital. Results ISAR+/CGA abnormal patients spent more days in hospital (16.1 ± 14.5), received more nursing hours per day (3.0 ± 2.3), more hours of physiotherapy during their hospital stay (2.2 ± 3.2), and had more falls (10.1%) compared to ISAR+/CGA normal (10.9 ± 12.3, 2.0 ± 1.2, 1.2 ± 4.3, and 2.8%, respectively, all p ≤ 0.016) and ISAR- (9.6 ± 11.5, 2.3 ± 4.5, 0.7 ± 2.0, and 2.2%, respectively, all p ≤ 0.002) patients. ISAR+/CGA abnormal patients terminated their treatment regularly with being discharged back home less often (59.6%) compared to ISAR+/CGA normal (78.5%, p = 0.002) and ISAR- (78.2%, p = 0.056) patients. ISAR cutoff≥2 and CGA defined as abnormal in case of impairment of ADL plus another CGA domain achieved best sensitivity/specificity. Conclusions Abnormal geriatric risk screening and assessment are associated with longer hospital stay and higher amount of nursing and physiotherapy during hospital stay, greater risk of falling, and a lower percentage of successfully terminated treatment in older in-patients.

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Identification of Seniors at Risk (ISAR) Screening Tool in the Emergency Department: Implementation Using the Plan-Do-Study-Act Model and Validation Results

Cited by 39 publications

References 13 publications

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework

Health outcome of older hospitalized patients in internal medicine environments evaluated by Identification of Seniors at Risk (ISAR) screening and geriatric assessment

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